Gastric Bypass is no easy solution

So an old friend of mine from high school gained a lot of weight and decided that gastric bypass surgery was the best answer to her weight-related concerns. She's been facebooking about it for months now and this week she finally had her surgery. I've been watching her progress with an uneasy curiosity since she announced she would have the surgery, wanting to tell her just how effed up I think the whole thing is but also recognizing that she is an adult and has to make her own decisions. Anyway, she has a blog where she has been documenting the process and I was just struck by this entry about how restrictive the pre-surgery and post-surgery eating requirements are. If you've ever spent one second of your fat life thinking "maybe I should consider that gastric bypass surgery", this will make you glad you passed it up. Check it out.

While blogging, I'm also having my "dinner". Tonight that is one cup of strained low fat cream of chicken soup. (Strained to get the chunks of chicken out!) My diet is extremely limited right now, which of course is to be expected. People are shocked when I tell them, but my tiny little stomach pocket just isn't up for too much yet! And since my understanding is that if I over do it the results will be quite uncomfortable for me, I'm not pushing it! (-:

The great news is that I am not feeling terribly hungry, and when I do feel slightly hungry, it is typically because it's time to eat something.

Days 3-6 (where I am right now)-- Full Liquids (1% milk, low carb protein shakes, SF low fat yogurt, cream of chicken soup, plus all the things in clear liquids -- including SF jello, and SF popsicles) **now, the surprising thing here is the quantities... I should take a full hour to sip 8 ounces of whatever I eat/drink, yet I am to strive to consume at least 48-64 ounces of liquids over the the course of the day. Half should be clear liquids and half should be the full liquids, being sure to get protein in there.

Days 7-10 (begins Wednesday - woo, hoo!) -- Pureed/Soft Diet --- this is where my new magic bullet will be quite handy. See, my tiny new pouch isn't grown up enough to work as your stomach does.... using its muscles to break up and grind up the food we eat. So, for now, I gotta do that work before I eat something. Now, at this stage, I shall only eat 4-6 Tablespoons of food each "meal" and I should have 5-6 meals a day. I can add mashed potatoes, custard, and pudding, but I must be VERY careful to keep it really low sugar and really low fat. Otherwise, my tiny pouch will rebel and make me regret it. Other things, provided they are well cooked and blenderized, will be vegetables, scrambled eggs, LF cottage cheese, poultry, soups, applesauce, and stage 1 & 2 baby foods (but watch the sugar in those!). I must also be sure to remove all skins, visible fat, connective tissues, rinds, shells, seeds, etc.

Then, Days 11-30 (almost 3 weeks) -- Soft Diet -- Pretty much as above, but adding a few starches like cereal, crackers, and adding soft fruits (have to remove citrus membranes) and low fat cheeses. The instructions say "small distinct pieces of food that is tender and easily chewed. Begin with ground or flaked meats and chopped or mashed foods".

Then, Days 31-45 (two weeks) -- we continue as above, but get to graduate to 6-8 tablespoons per meal, 5 meals per day. Also can add some things like brown rice and whole grain pasta.

Then, Six weeks after surgery -- Healthy, Lifelong Meal Plan -- add a few tablespoons of food per meal, then after another month, a little more. Ultimately, the plan for post bariatric surgery patients, is to eat 3/4 - 1 cup per meal, and eat 4 small meals per day. Dr. XXXXX disagrees with the snacking throughout the day theory. Essentially, we'll need to add more fiber here, but be intentional about high protein, low fat, and lower carbs. We are told to stay away from everything High Sugar. My understanding is that high sugar will result in dumping syndrome, and that I will not like that one bit. (-; A few people have said, "yep, you'll only do that ONCE".

A few other things for post bariatric surgery patients, that are a little odd, are that we can no longer drink from straws or have carbonated beverages. Those put too much air in our pouches, and make us feel full when we aren't. Also don't want those bubbles to increase the size of the pouch, that would be dumb after having surgery, no!?

Another quirk is that we are NOT to drink while eating a meal. Yes, we must drink 48-64 ounces daily, but we must stop drinking 30 minutes before a meal, and not drink fluids again until 30 minutes after a meal. Our little pouches (can you tell I've grown attached to my little pouch already? (-: ) will tell us we've had enough to eat and we would not have. Or, the food will slide right through with the liquids, and we won't get the nutrition we need. Either way, that's bad. SOOOO, no drinking at meals!!!

Oh, and NO MORE NSAIDS. I know, what's that, right? No more aspirin or anti-inflammatory medicines like Aleve, Ibuprofen. EVER. They're bad for our little pouches. They can cause bleeding and ulcers, and bad stuff like that. Oh, except the chewable baby aspirin we take for the first month after surgery to prevent blood clots....

We must also take vitamins for ever and ever amen. Chewable Multivitamins with Iron and chewable Calcium with Vitamin D. And B-12. Can be shots or sublingual... I'll find out a bit more about that when I return to the doctor next Wednesday.

The part that shocked me the most was that it should take you an hour to drink 8 ounces of fluid. An HOUR. Also, four cups of food a day? How is it remotely possible to get the nutrients your body needs on four cups of food a day? And no straws?! That...ahem...sucks.

Anyone have any other thoughts on this? Is there anyone out there who has gone through this and can comment?

I had a lap-band. Then I had it removed after 2 years. The restrictions on drinking meant that exercise was difficult. And while I've felt emotionally broken for years, those two years were the only time I've felt physically broken.

And this is supposed to be healthy?!?
Bad enough when you're ill and have to go through some major surgery, but this? Maybe we should have our sex organs removed too, just because they MIGHT get cancerous some day.
I wish you could have said something, even though odds are greatly in favor of her not listening. Yes, she's a grown-up and can make her own decisions, but who can make an intelligent decision by hearing only one side of the story?
Omnifrog, it's a good thing your operation was reversible. I hope you have been able to regain your health and wholeness.

On taking an hour to drink a liquid - I've been known to do that, but not when I'm particularly thirsty.

Some ignoramuses say that fat acceptance is the "easy way out". As long as there are more fat people who would prefer gastric bypass (for weight loss) to fat acceptance, just the opposite will remain true.

I recently had a nasty case of salmonella poisoning (most likely from eating an egg from a sick chicken). What's described here is a little similar, but worse and much more drawn out. And I can tell you, I've rarely felt so weak and sick.

A friend of mine from high school had WLS 4 years ago, and she's already developed nutritional deficiencies. She has had to add weekly injections to her schedule of supplements. She lost a lot of weight but is still has a BMI over 40. Her surgery is considered a success.

DeeLeigh:
By "easy way out", I mean that an ignoramus thinks along the lines of "You only believe in fat acceptance because you're a lazy pig who's looking for any excuse to keep stuffing your piehole and never move a muscle except to open the refrigerator door.".

DebraSY:
Humans have been known to remove, cripple or disfigure other body parts in order to enhance physical attractiveness or acceptability. Consider clitoridectomy, or footbinding, which involved crippling the feet of young girls.

Next on the agenda: reducing gambling problems by making gamblers use smaller wallets.

You need to keep in mind that the extreme eating restrictions are *temporary.* Moving from clear liquids to opaque, thicker liquids to pureed food to normal eating also takes places after *any* digestive surgery, though usually faster than after gastric bypass.

I had a roux-en-y gastric bypass just over a year ago and can now eat pretty much anything I want except for sweets-- only not much of it! Steak, French fries, even Diet Coke (though tolerating carbonation is the latest development: just showed up this week ).

Too much sugar leads right to dumping syndrome (perhaps a beneficial thing, since sweets were -- and still are -- my weakness).

Of course, I can't speak for everyone, but losing ~100 pounds in a year has given me several benefits:
1. My diabetes is in remission. My last A1C was under 6 without any medications or diet modifications.
2. I'm off high blood pressure medication now.
3. I find it MUCH easier to move and to breathe.

The question is, will the weight STAY off? Even after the surgery, the body still tries to return to its setpoint.

Yes, people can and DO regain the weight after the surgery *unless* they work at keeping it off.

As my surgeon said, "Gastric bypass doesn't turn fat people into thin people. It turns fat people into less-fat people." I'm still fat, only more mobile. I can fit into theater and airplane seats now. I don't have to look for the handicapped stall in a public bathroom any more. I'm not restricted to shopping for clothes in the two local "fat stores" (or online).

I strongly suspect that, if I can keep the weight off, I'll have a higher life expectancy. (FYI, this is based on my situation with diabetes and high blood pressure, not on the media's assumption that fat=unhealthy).

No, gastric bypass isn't easy -- and it isn't for everyone. It has all the risks of any other surgery, and you're right about it being the only surgery that deliberately cripples an otherwise-healthy organ. I believe that after science figures out how to turn off people's "fat genes" (in all their variety), gastric bypass will be seen as barbaric, bizarre and horiffic, rather like Dr. McCoy's reaction to dialysis in "Star Trek IV: The Voyage Home." What the good doctor failed to take into account is that the beleaguered twentieth-century physicians didn't have access to his magic-kidney-regrowing pills: dialysis was the best they could do at the time. Likewise with gastric bypass. It's the best we can do right now, but it's not a permanent solution. As someone on this board always says after someone else brings up the social pressure/discrimination against fat, "If (insert weight-loss method here) worked, there wouldn't be any fat people."

Surgery of any kind is a calculated risk. Only the patient can decide whether the risk is worth it to him or her. (And before anyone posts about his, yes, I know we may not be aware of all the long-term risks and side effects of the surgery -- but so far, so good).

Yes, people can and DO regain the weight after the surgery *unless* they work at keeping it off.

Geez, do we need these types of comments here? I'm not judging your choices here, but try to lay off the moralizing. Fat people put up with this type of judgmental lecturing all the time, and it's not helpful here.

You could easily replace "the surgery" with "the diet" here - not a big difference. As if the rest of us haven't "worked at it" the majority of our lives. Some of us just got TIRED of it, OK? Some of us don't feel that radical surgical procedures are going to save us - some of us don't WANT to take that risk.

I'm happy you are getting healthier, but don't assume that what works for you will work for anybody else. We're all different, and should have the right to make our own decisions on our bodies.

Sarahj, that wasn't moralizing, just* full disclosure* so readers at BFB won't mistake gastric bypass for a "magic bullet" that will let you eat as much as you want of anything you want, as often as you want. As long as you're not slaughtering PEOPLE for food, eating is a morally-neutral issue. (It even says so in the Bible, Matthew 15:11). Of course there are cultural/social/religious expectations and taboos, but you can be sure that just about anything that isn't outright toxic or poisonous has been or is being eaten by someone, somewhere.

As I said before, surgery is a kind of stopgap measure. The genuine problem is how fat people's bodies process food: I've noticed that neither I, nor any other fat people I know, eat any differently than thin people. Go ahead, challenge anyone you know to look around next time they're out at a restaurant and PERCEIVE this. I'm sure "they" (you know the ones) assume that while the fat person over there is eating "normally" right now, s/he goes home and gorges on Ben & Jerry's (or, as one witty BFBer once said, on "baby-flavored doughnuts").

Or perhaps the problem is modern typical-American food itself: refined sugar and carbs, high-fructose corn syrup, corn-fed meat, and preservatives. In short, we fat folks are the canaries in the coal mine, and the fat-epidemic-panic basically translates as "OMG, the canary's gone belly up!" The general public is getting fatter because they're catching up with us. (It wouldn't surprise me at all to find that some people, namely us, are more sensitive to these substances than others).

Either way we're being scapegoated for something over which we have no control. You can change neither your fat-storage process nor the food oligarchy by willpower, although there's a backlash starting against the oligarchy by the slow food / localvore/ organic movement.

I would love for someone (a credentialed scientist or medical researcher) to round up some fat and some skinny folks, confine them (with their permission, of course) and feed them the exact same things, measured down to the milligram, to test the hypothesis that the fat folks will store more energy (fat) than the thin folks and striking a solid blow against the "weight = calories in - calories out" assumption. Or has that already been done? If it has, why isn't the public listening?

I'm guessing that most BFB readers don't think of WLS as a "magic bullet," at least if they've been hanging around for a while. Who would think that invasive, destructive surgery is a magic bullet? Only an idiot or someone who hasn't really thought about it.

Most of the commentators here are very anti-WLS. Some have had negative experiences with it themselves; others have lost people close to them to it. Most of us wouldn't have it done if you paid us a million bucks.

You seem very rooted in seeing large bodies as problems that need to be solved, even if you believe that we're not at fault and that it's not a moral issue. Most of the commentators here don't see our bodies that way.

Biggoth, if fat people aren't eating more than thin people, and I believe that's mostly true, then what is the reasoning behind WLS? Is it not surgical starvation, or enforced bulimia? And as for those who adhere most strictly to the post-surgical dietary rules, do they live longer than those who are more lax? Do people who keep more of the weight off live longer than those who gradually regain?

Your'e right about the restaurant experiment. The same people will also assume that the thin person stuffing his face will eat little or nothing or home later to "balance out the extra calories".

I like your canary analogy, except that people seem intent on blaming the canary.

As for your proposed experiment with fat and thin people and calorie intake, who would you get to fund it? I would bet that some such experiment has been done, but the results were ignored because people didn't believe them, or twisted somehow in order to make fat people come off second best. The public doesn't listen because it is just too convenient to have a scapegoat around, some group next to whom it can convince itself that it's superior. Along those lines, even fat people often find somebody heavier with whom they compare themselves. Pecking order made easy.

[quote]Biggoth, if fat people aren't eating more than thin people, and I believe that's mostly true, then what is the reasoning behind WLS? Is it not surgical starvation, or enforced bulimia? And as for those who adhere most strictly to the post-surgical dietary rules, do they live longer than those who are more lax? Do people who keep more of the weight off live longer than those who gradually regain?[/quote]

In my case, it was for health. The jury is still out on how WLS affects lifespan, so all I can tell you is that WLS has improved my quality of life for now. It's still a risk: one of the ladies in the local WLS-support group DIED last year from complications, *three years after* her surgery.

Yes, it pretty much IS "surgical starvation," at least in the early stages. You're tempting me to segue into another claim, one that I believe but haven't discussed with my surgeon: When you restrict calories (diet), your body goes into calorie-hoarding mode. It's convinced it's STARVING TO DEATH, so the survival instincts buried deep within your brain will start prodding (and eventually YELLING at) you to eat something, anything! I can't think of any group, other than dieters, who are expected to fight their own survival instincts for months, years, decades. It can't be done -- that's why diets fail. People can fight those instincts in the heat of the moment (for example, a soldier who throws himself on a grenade to save his buddies) but not year after year after year. It's INSANE to expect them to. Those instincts are too deeply inbedded -- after all, even a one-celled creature like a paramecium will move *towards* food but *away from* a painful electric jolt.

Six to nine months after WLS, the new stomach pouch will expand a bit. After that you can pretty easily take in enough calories to stop the weight loss, so the "surgical starvation" is only temporary. Still, it gives you a head start. I've lost more weight a year after WLS than I ever did with the many, many diets I tried. (The runner-up would be Atkins at 60 pounds). You name it, I tried it, except for the grapefruit diet 'cause I detest grapefruit. (I often wonder why anyone bothered breeding 'em from pummelos, which I like). I started gaining weight right before puberty -- and no one ask me how long ago that was! -- and never stopped. Yo-yo'd up to 331 pounds before surgery, 197 today.

I know, I know. Some folks here will be waiting for the shoe to drop (or a Sword of Damocles to fall). Maybe it will, maybe it won't: the fact is, WLS isn't perfect (much less safe); it's a desperate, last-ditch attempt to lose weight that works *for some people.* I know I'm datin' myself here, but I remember when desperate people would have their jaws wired shut in order to lose weight. It's THE MOST DRASTIC weightloss measure you can take today (though some procedures, like the "duodenal switch," are more involved than others).

Someday, after medical science has figured out how to manipulate the brain/gut/appetite/satiety/survival instinct/epigenetics puzzle, people will look back on WLS and wonder why anyone would ever go through with it.

As for funding a study, do you think it'd be possible to get a government grant? Maybe if we (I mean, the researchers) spin it as exploring the connections between poverty and obesity, even though they're so obvious they shouldn't need one (isn't that the way with *most* government studies?).

Heck, maybe we should pitch it to a network as a new reality show! You'd have no shortage of volunteers, and the entire country could potentially tune in -- you could counter the prejudices and assumptions of many people at once AND portray fat people as, you know, PEOPLE, instead of the stereotypes with feet that populate the few shows that feature fat people at all.

You'd need some kind of suspense to keep viewers' attention, though, and I don't think this could be set up as a competition. How 'bout if we talk Big Diet Industry into making a lil' wager, say $5 million? If the experiment proves weight=calories in - calories out, they win, and fat activists have to offer a public apology on the finale of the show. If they lose, the money gets split between NAAFA and BFB (and perhaps other fat activist organizations).

The idea that the 'fat' body is a 'broken' body is largely bad science commissioned by the moral panic.

SHAMELESS PLUG!

Oh, and the Fat Nutritionist has a bunch of great links to studies on her sidebar, too. So don't take OUR words for it.

Listen, there are lots of ways one can lose weight that WORK temporarily (or permanently if you don't care about the quality of your life besides being thinner), but that doesn't mean we should undertake them, because fat bodies aren't broken thin bodies.

Biggoth, I do appreciate your point of view, and you appear to have gone into surgery being as aware as possible of the risks. I read another interesting take on WLS on Shapely Prose awhile back from a woman named Heidi who actually did have the surgery for health reasons. She was and probably still is dead set against the operation, but the doctors she consulted for a different real and quite painful problem REFUSED TO TREAT HER unless she had the surgery. I found that horrifying. Perhaps someone better informed about the outcome can tell us how things went afterwards (or provide a link).

In a better, kinder, more knowledgeable world, the cause of your unstoppable weight gain would be investigated with the seriousness that is more often given to unstoppable weight loss, and treated accordingly.

Who would sponsor your proposed reality show? Would it alternate between, say, a diet company and a plus size fashion ad? I don't think the idea would go over in today's climate. First, it's not as if people just want to see fat people on diets; they want to see us obviously SUFFERING. Crying, fainting, vomiting, humiliation.... THAT'S what brings in the bux. Dispassionate scientific experiments? Straight to the circular file. And there are too many confounding factors for this experiment to prove anything to doubters.

I didn't say anything about trolling, Debra. It's just that I was wondering why biggoth had joined a fat acceptance forum. She has recently lost a lot of weight herself, and she shows a huge interest in discussing why people are fat and what can be done about it. I'm asking myself "How is that fat acceptance? Is that even compatible with fat acceptance?"

Don't get me wrong. I'm sure those can be an interesting topics. A lot of people say that there's no place to discuss things like that without an atmosphere of fat hatred and contempt for fat people, and I can certainly understand that complaint. The idea that people are getting much fatter, that it is a problem, and that medical science needs to figure out why and find a way to make fat people thin... that's actually very mainstream.

I don't see biggoth questioning any of those assumptions, and this is the only discussion I've seen her take part in.

Biggoth, sorry for talking about you in the third person. I'm just wondering if you are interested in fat acceptance. What are your views on it? I'll set up a topic on the forums to discuss it...

DebraSY wrote:
[blockquote]I think you and I are on common ground: we agree that something has happened rapidly to the weight and shape of the human form. In less than four decades, the bell curve has shifted upward roughly 24 pounds at the center, and morphed and flattened on the upper end of the weight specturm. Yet cultural mythology perpetuates the notion that fat people "choose" some unhealthy "lifestyle" that causes them to be fat.

I don't know if the bell curve shift has been caused by bovine growth hormone, trans fats, too much corn or soy in our diets, TBHQ, pesticides, phlatates or some other endocrine disruptor, but I'm pretty sure that it's not people suddenly choosing to become social pariahs because it is some bang-up kind of lifestyle.
[/blockquote]

Exactly! With all the social penalties for being fat, no sane person would choose it.

A few clarifications about myself for those who are wondering:

First, I'm a girl.

Second, I've been a member of BFB for almost four years (check my profile if you want to verify). Yes, I'm new at posting, but I've been lurking for a long, long time. I probably wouldn't have posted in this thread at all if the original topic hadn't *asked for input from people who've had WLS, specifically.*

I'm not a troll -- and hope I don't come across like one -- and have no intention of pushing WLS on anyone. For all I know, I could develop life-threatening (or even -ending) complications ten minutes from now and regret the surgery more than anything I've ever done in my life -- in which case, if I'm still alive and capable of posting, I'll let y'all know.

Third, I'm still fat and probably always will be -- just less fat than before. Yes, I'm down to 197 pounds now, but I'm still short and stocky -- broad shoulders, wide childbearing hips, short arms and legs, and no waist. If there were a magic pill that would instantly take away every single excess fat cell in my body, I STILL would never fit the current beauty ideal (and that's all right: I decided a long time ago that I'd rather have a useful life than a decorative one).

Fourth, someone asked about my position on fat acceptance. Basically fat people should be seen as PEOPLE first. No one should be denied medical care or a job because of their size -- unless their size makes them unable to do the job. Businesses should accommodate a wider range of sizes (no pun intended) as enlightened self-interest. How hard would it be, after all, to put a few "bench style" seats in movie theaters, arenas, buses, amusement-park rides, and planes? More customers = more profits.

There IS such a thing as being too fat -- namely, being bedridden by it when you don't want to be. No one in their right mind would choose that, either. This is when fat DOES become a problem in search of a solution -- which, alas, may not exist. While most of the time "fat bodies aren't broken thin bodies," sometimes they ARE broken, particularly in these extreme cases. I'm not a doctor or anything, but I wouldn't be surprise if some of the extremely obese turned out to have an underlying metabolic condition, discovered or not.

Fifth, weight loss (or weight maintenance) takes an inordinate amount of time and energy that could better be spent on other things. I spend more time than I like to admit adapting recipes, searching for new ones, and going to exercise classes, all to keep the weight off. Much of this is by the hubby's request: he had WLS 4 years ago and has started regaining and is in a panic. He believes, with some reason, that if he hadn't had the surgery he would've been bedridden for the rest of his life.

Sixth, I've done some bits for the cause. I'm a teacher. In addition to running a website for plus-size dancers, I get students to question their assumptions (prejudices) about fat people as part of an assignment on "Stereotypes." I tell them I'm using myself as an example (I've found that students *hate* being singled out for their "difference," whatever it is, in front of the class, so this works well). One of the tools I use is the Harvard Implicit Associations Test for weight here: https://implicit.harvard.edu/implicit/demo/selectatest.html
. I also challenge the class to think of any fat fictional characters who aren't portrayed as losers, gluttons, the comic relief, or some combination of the above. It's a short, short list. We examine the social construction of fatness; many of my students, bless their hearts, have no notion of history at ALL and think things have ALWAYS been the way they are now, only with new high-tech gadgets. They're *amazed* to learn that once upon a time plumpness was socially (and sexually) desirable because only the poor and/or sick were thin. I could go on, but I have to dash off to dance class in 30 minutes.

(It's been awhile since I've updated, though: for one thing, the hubby and I upgraded with a new computer and Windows 7 over Christmas break, and while we bought Office 2007, it didn't include FrontPage, which is what I used to use to update. I sure hope "Word" will do the trick!).

biggoth says: "There IS such a thing as being too fat -- namely, being bedridden by it when you don't want to be. No one in their right mind would choose that, either. This is when fat DOES become a problem in search of a solution -- which, alas, may not exist. While most of the time "fat bodies aren't broken thin bodies," sometimes they ARE broken, particularly in these extreme cases. I'm not a doctor or anything, but I wouldn't be surprise if some of the extremely obese turned out to have an underlying metabolic condition, discovered or not."

Using a straw fatty isn't going to make your argument sound.

And no, not even a bedridden fat person is a broken thin person. Nor are they broken in any sense. STRONG whiff of ableism in that statement. People are different, including their abilities and health statuses.

Health is individual and should be dealt with as the person involved seems fit. But generalizing and prosthelytizing about WLS --- and yes, coming to an FA board and claiming that WLS is right for 'some' people is prosthelytizing. Because:

1. We have heard it before.
2. We're not stupid. We do understand what it means to be an extreme case (NOT the vast majority of fatties, btw). Speaking out against the widespread acceptance of WLS and dieting, highlighting their caveats and their complicated relationship with the moral panic known as the 'obesity epidemic' doesn't mean we're somehow saying that someone who is bedridden SHOULD remain that way if they think the risk of drastic surgery, complications, and likely regain is worth it.
3. Being a member of BFB for several years doesn't mean you're automatically FA/SA (and we have had, btw, trolls that fly under the radar for years).

And, finally:

4. "Exactly! With all the social penalties for being fat, no sane person would choose it. "

I'm choosing it (in that, I *could* get WLS, starve and exercise binge for years and year to stay thinner --- which I've done), and I'm plenty sane. The "fat magic pill" fallacious argument that I hear most often from --- you got it, concern trolls --- is little better than a test for whether the person postulating the "magic pill" question is themselves is truly size accepting.

By the way --- the time of my life when I was least sane? Was when I was trying to fight my body. So yeah, your comment is pretty offensive, IMHO. I don't think I'm the only person in FA/SA who thinks so.

(just as a note, when did it become MORE sane to want to change someone's natural body shape, anyway? In a social vacuum that sounds pretty damn irrational to me)

And while I agree that one can hypothetically be a good SA activist even if they are a dieter/WLS advocate in that you can be an activist against straight-up fat bigotry (as you seem to be doing in your teaching), but as for the other major foundation block of the moral panic --- the social disapproval inherent in the 'public health crisis' of obesity --- you look like a hypocrite.

"Someday, after medical science has figured out how to manipulate the brain/gut/appetite/satiety/survival instinct/epigenetics puzzle, people will look back on WLS and wonder why anyone would ever go through with it."

Maybe, but I'd still much rather see a world where social scientists and fat activists have figured out how to 'manipulate' social mores and public perception to the point that fat people are respected as human beings and accommodated as consumers in the same way as any other group, thus negating the desire for weight loss whether through surgery, neuroscience, drugs, gene therapy, eugenics or whatever other attempts to make us all fit into that cookie cutter that they may dream up in the meantime. One of the reasons I dislike the current popularity of WLS so much is that through 'thinning' the numbers of fat people and turning potential activists into cheerleaders for the importance of being thin, it further reduces the possibility that the movement will ever achieve the critical mass needed to effect this essential paradigm shift, since the largely irreversible nature of it means that even those who experience problems are unlikely to condemn the procedure due to the degree of their emotional and social investment in it.

I know that most people who support WLS justify it on the 'health benefits' (even if their true motivation is conformity or just the desire to change themselves to fit a world and society that's set up for thin people) which is ironic because in my experience the one thing WLS does not do is make you healthy. It might provide the temporary ILLUSION of health (as you point out Biggoth, even such a drastic procedure doesn't prevent regain without the sort of subsequent dieting and restriction that is notoriously difficult to sustain) in a world that conflates it with body size. However the few people I know who've had the surgery generally rue the constant pain, digestive problems, associated conditions and in some cases numerous surgical revisions they've traded for no longer being AS fat as previously, even if they acknowledge that the social benefits of being thin in a fat-loathing world nevertheless outweigh these costs.

"When people fear the government, there is tyranny; when government fears the people, there is liberty." - Thomas Jefferson

Been there done that, and it failed, spectacularly. I had a VBG almost 12 years ago, and I would have been better off, physically, if I'd never had it done. Not only would I be 40 lbs lighter than I am now, I wouldn't be dealing with complications like increased mobility issues, fibromyalgia, and digestion issues that keep me close to a bathroom after eating certain foods (and it's not always the same foods).
I lost almost 70 lbs in about 6 months, after my VBG, mainly because I couldn't eat anything that wasn't pureed (anything that wasn't pureed came right back up, no matter how well I chewed it). After that initial weight loss, I slowly started regaining weight, even though I was still having trouble eating anything that wasn't pureed. I ended up gaining back every pound I lost and 40 more (and if I had known my nurse practitioner had lied to me about surgeons not doing knee replacements on fat people, I never would have had the VBG in the first place).
Even now, almost 12 years later, there are still foods I have trouble eating. It still takes me 30 to 45 minutes to eat a meal, even if it's just a sandwich and some chips. I have to stay away from anything that has a lot of sugar or a lot of grease in it (explosive diarrhea is not something you want to deal with in a public space, take it from me, been there done that). I love salads, but I can't eat them unless I'm at home, because salads do the same thing as too much sugar or too much grease. When DH and I go out to eat, I have to limit what I eat to a very few things that I know won't affect me in that way. And at that, I'm lucky - I don't have near the complications of other WLS survivors, nor did I die like my best friend, Pat, did after she had 2 VBGs.
After my experience, and losing my best friend to this travesty of a so-called "cure" for fat, I'm adamantly against WLS. Hindsight is 20/20, but if I had known then what I know now, I'd never have gone through with the VBG. I just wish I'd have been online back then and known about FA.

While my weight makes me a good candidate for WLS, I'm not doing it. I have severe anemia and I already have to take an iron pill everyday. I don't want to be on countless vitamins for the rest of my life because the surgery zapped the nutrients I already have in my body. I also have IBS with chronic constipation, which is controlled with lactulose and right now I'm doing extremely well. The last thing I want is to always be scared of dumping syndrome, which I suffered with for a while after gall bladder surgery.

I realize many people do well after WLS, but the risk of complications far outweigh the benefits, pardon the pun. Also, it's not seen as a last resort for people in critical health due to weight anymore, it's a cosmetic procedure pushed on anyone that is remotely viewed as fat, even if they're not "morbidly obese."

Why trade my relatively healthy deathfat body for a slightly smaller, possibly even more unhealthy body simply because society can't stand the sight of me? Society will just have to deal.

To get back to what caused a shift in average weights of people in America - There are 2 possible causes that are not usually discussed:

Weight Loss attempts

Aging Baby Boomer Demographic

Starting about 1990, there have been a HUGE ramping up of anti-fat/obesity-epidemic articles in the media following some well publicized articles in the mid-80s on weight-loss-regain. In the late 80s, the weight loss industry was in the financial crapper, after it became general knowledge that weight loss attempts usually result in failure. The industry had to do something PR-wise and so (it seems to me) that they invented the obesity crisis and the "rising of average weights".

How much has that intense media focus pushed people to diet/lose/regain?

How much does the Baby Boomer Demographic hitting their 50s and 60s affect average weights?

I personally don't think there has been any big shifts in the weight distribution of people; I think the so-called obesity epidemic is a figment of the imagination of the weight loss industry.

I'm inclined to agree with Carolyn; from what I can tell there are potentially a number of factors influencing a statistical rise in the number of fat people that has been termed 'epidemic'. In addition to the issues of measuring and labelling, including increased use of the BMI for diagnosis and the revisions to that scale, there have been changes in society that in the last 50-80 years have seen most of us gain access to a stable and plentiful supply of food and a move away from jobs involving hard manual labour, allowing those who always had a capacity for fat storage to reach our 'genetic potential'. I've even heard it suggested that as discrimination against fat people has increased (ten-fold since 2004 if one study is to be believed) we're more likely to marry others like ourselves, increasing the likelihood that our 'thrifty' genes will be passed on.

Whilst I partly agree with Debra's assertion that there may have been a slight increase in the numbers of larger people, I suspect that it's as much an issue of perception: for instance I don't see all these thousands of fat children whose presence provokes so much hand-wringing, to me the proportions of fat to thin are similar to when i was in school 20 years ago, though of course the fat panic industry dismisses this by claiming that what we've erroneously come to regard as 'normal' is actually itself deviant.

Back on WLS and following on from Bree's comments about it being a last resort, even one of the surgeons who pioneered it was quoted a couple of years back as saying that the idea that it should be a fix-all cosmetic procedure for everyone labelled 'obese' was insane. Unfortunately it would appear that most of his colleagues in the business had no such scruples when they realised just how lucrative it could be, with the result that in some areas there's almost now an unwritten expectation and a great deal of pressure upon fat people to apply for and undergo some form of weight-loss surgery.

"When people fear the government, there is tyranny; when government fears the people, there is liberty." - Thomas Jefferson

"She's feeling her way as carefully as any of us. BL, you have had your days of being less than, er, politic."

I can be compassionate as the next person, but I'm not in the business of shutting my mouth when I'm being called insane for holding a stance that is supported by the space (BFB) on which I'm being called insane.

I'm not sure exactly what the 'less than politic' thing is going for, DebraSY, except to somehow without citing specifics degrade my message, which is that coming into BFB and beating on the 'not ALL fatties are healthy and individuals who get WLS can do what they want' as some kind of rebuttal of the widespread ill effects and questionable social consequences of the mutilation of a healthy organ --- sorry, BINGO! Perhaps we need new cards? --- is concern troll-y, regardless of lip-service to some kind of hypocritical compassion.

I think there a confusion here between general dieters as size acceptance activists (which is possible, which you embody, Debra) and concern troll-y posts which praise what size activism largely considers to be a very dangerous surgery on a healthy organ increasingly marketed to healthy fat people under duress. It is a fallacy that FA doesn't agree that WLS could 'work' for some people, that some fat people are differently abled, and so on. There is no new ground being covered here, just some axe grinding, and it's tiresome and offensive.

I take umbrage to bigoted statements like the "magic pill" fallacy get spewed without much pushback from regular commenters here. And with all due respect being 'politic' is unsuitable when it requires degrading a foundation block of the movement. If we were always 'politic' social activists wouldn't exist, things would never change, etc.

Richie - not only is there pressure on fat people to undergo WLS, but if the first WLS fails, like my VBG did, then they want you to undergo a more radical, 2nd WLS in order to see if that will be successful. And like I told the doctor who recommended that I have an RnY after my VBG failed - "Nope, y'all had your one chance to kill me and one chance is all you get. Sorry, no takers here." For some reason, he didn't find that acceptable (or funny), but "too bad so sad sucked to be him" was my response to that.
All I can say now is thank maude for the internet and FA/SA, which I didn't have back when I had my VBG.

[blockquote]And no, not even a bedridden fat person is a broken thin person. Nor are they broken in any sense. STRONG whiff of ableism in that statement. People are different, including their abilities and health statuses. [/blockquote]

Being bedridden when one doesn't *have* to be is a colossal waste of human potential (no matter the cause). We could argue all day about whether the treatment (whatever it is) is worth the risks, but the fact remains that most people would rather be up and about and able to leave the house/hospital.

"...but the fact remains that most people would rather be up and about and able to leave the house/hospital."

WLS IS NOT A MAGIC BULLET

Pretending this is a case is ignoring a growing body of evidence that suggests forced starvation and bulimia isn't good for you, that WLS only sends diabetes temporarily into remission, that weight loss associated with WLS is temporary, that the side effects (consequences of nutritional deficiency and major surgery) of WLS lower quality of life to a point where yes, it's questionable whether being a fat bedridden individual is worse than getting WLS. And yes, this is also taking into accounted that this whole Discovery Health version of who is really getting WLS in droves (a very small percentage which is the hypothetical bed-ridden fatty) is a straw argument, and beating on that drum isn't advancing your argument.

"...but the fact remains that most people would rather be up and about and able to leave the house/hospital."

WLS IS NOT A MAGIC BULLET

I never said it was . . . in fact, there's an interchange earlier in the thread when I explained *in those exact words* that WLS isn't a magic bullet and that after surgery people still have to work to keep the weight off.

Nor am I saying that WLS will magically make people bedridden by their weight suddenly able to get up. Take weight out of the equation entirely . . . Someone who is bedridden for *some other cause,* if offered a treatment for the *some other cause,* would probably consider it. S/he might reject it, but would at least look into it.

I hope I'll be an exception to WLS not working. I'd hate to go through all this for nothing, which is basically what dieting amounted to. False hope again.

I think we agree on the "Weight Loss Channel." They never show normal, average fat people leading normal, happy lives. "Normal" won't get ratings.

You have to understand where I'm coming from, in that I believe quite strongly that WLS is the lobotomy of our day. I believe it is mutilation and not surgery. I believe that it is being perpetrated on a particular 'deviant' class of people specifically without careful regard to outcome in order to rid society of the 'disease.'

I know I'm radical and upfront about my anger and my educated opinions, and thank you for responding to them.

While most of the time "fat bodies aren't broken thin bodies," sometimes they ARE broken, particularly in these extreme cases.

Perhaps there's a better way of saying it.

Fat bodies aren't broken thin bodies *because they are fat,* but they may be fat because they are broken. If what's broken gets treated, someone who is naturally thin may indeed loose the weight, but loosing the weight isn't going to fix what's broken - and that's where dieting and WLS largely fails. It's treating something that either has nothing to do with what's broken, or is a symptom of what's broken. It'd be like giving someone painkillers to treat a broken arm.

I think this is one of those area's where weight loss philosophies grinds up against body autonomy and the traumatic bruising is almost immediate.

There are, in fact, people out here who, if offered the guaranteed-to-work, nontoxic-and-safe, zero-side-effects, low-dosage, magical, make-me-acceptanbly-thin, weight loss pill, would turn it down FLAT. They exist, I'm one of them. We have no problems with being fat or, perhaps, are satisfied enough with our lives that whatever OTHER people might CONSIDER problems, for us, just aren't. It's all part of my body being, yah know, mine and it also ties in nicely with the whole, 'people are different', thing. If this magical pill came out tomorrow and 99.99999999 (to recycle a favorite Troll Statistic) of the earths population actually took it, believe me, there would still be those who refused and there would also be those who regretted they did. Why? Who the hell wants to be JUST LIKE EVERYBODY ELSE.

This is one of the reasons why I and a few other here (Richie I'm glancing in your direction) find statements like 'In the future they'll find a way to eradicate obesity' and 'When science finds a way to turn off the fat gene' so, frankly, terrifying. I AM fat, I identify as fat, all I hear when someone makes statements like these is 'They want to find ways to eradicate ME'.

The world is on the verge of several microbiological and genetic break-throughs, we have successfully CREATED life by combining inorganic proteins in a test tube. Whole HOSTS of genetic malfunctions and naturally occurring coding errors are killing people in excruciatingly slow and painful ways and we are this close to figuring out how to fix them. But the first thing ANYBODY ever thinks of in regards to genetic manipulation is. . . . . Obesity . Followed closely by how to make our children smarter. Anybody who's read any kind of science fiction, ever, should know the dangers inherent and fundamental to that kind of thinking.

Fatness is PART of human diversity and SHOULD NOT be eradicated. Even our beloved Gene Roddenberry managed to overlook that little fact. How many characters on ANY of his shows where fat? Of the few fat ones, how many where human? Of the few fat ALIENS, how many were portrayed as comparably intelligent? In his version of a progressive, culturally diverse, inherently smart, humanity, there was only room for the 'Physically Fit'. Even Differently Abled folk got a nod (Geordi Laforge was blind), but fat people just did not exist. And, frankly, that's one of the reasons why I sometimes found / find Star Trek, kinda boring.

This is one of the reasons why I and a few other here (Richie I'm glancing in your direction) find statements like 'In the future they'll find a way to eradicate obesity' and 'When science finds a way to turn off the fat gene' so, frankly, terrifying. I AM fat, I identify as fat, all I hear when someone makes statements like these is 'They want to find ways to eradicate ME'.

Spot on B4C. I wouldn't take that magic pill if it came with a bonus million-dollar cheque attached. OK, it would be *nice* if I could fit into one of the ridiculously tiny seats on my morning bus, or not have to hunt round twenty clothes shops for the last pair of 44" waist work trousers or a T-shirt that covers more than one arm, but those are all things that can be changed without forcing fat people to fit a world from which the dominant thin have excluded us, and they're certainly not worth breaking a body that works perfectly well for. And yes, I identify as fat. I think fat people are beautiful (by my own definition of aesthetic appeal, not an externally-imposed one) and a world with no fat people in it would be infintely poorer. That's just my personal opinion of course, but whilst it's no more valid than anyone else's, it annoys me that it's generally condemned as wrong or illegitimate. Maybe I AM wired up all wrong, or maybe the rest of the world is. Who knows.

Wary of invoking Godwins Law, I recall another time in history where doctors were co-opted into the process of bringing about someone else's wet-dream of a world where everyone looked just the same. It does terrify me that in an not inconsiderable space of time from now we will not only have the dark will to make such a society happen but also the technical means. I do fear that one day people like me will be forcibly 'broken' in order to conform to what a tyrannical majority have decided constitutes 'right' or 'healthy'. It's already happening to an extent - many fat people are being to all intents and purposes forced to undergo surgeries or subject themselves to diets they wouldn't consider if that vital operation or dream job or just the right to parent their own children or adopt someone else's didn't rest on it, if that obstacle hadn't first been placed there by one of the privileged thin. One of the reasons I'm so against WLS is that no-one makes a truly informed, value neutral personal choice to get it; how could they, in such a world?

My thoughts on the utter lunacy (from a survival of the species perspective) of disabling a biological mechanism that's seen us through ice ages, concentration camps, famines and more, in an immense, interlinked world whose very complexity is its vulnerability and a stable food supply a recent luxury that's by no means assured ten or a hundred years from now, are well-known. And I hear you too on the monumental WASTE of expertise and research resources that have and are being ploughed into the ultimately futile, low-priority task of ironing out all variations in human size, for what? A Gattaca-esque world full of supermodel extras? Something really worth diverting funding from research into demetia or AIDS or bipolar disorder or any other of a million indescribably cruel conditions that rob people of their quality of life and ultimately their loved ones. All because some people have been brainwashed into not wanting to look at at people, because instead of turning their heads and looking at something they DO enjoy they feel entitled to demand the removal of that which offends them.

"When people fear the government, there is tyranny; when government fears the people, there is liberty." - Thomas Jefferson

I'd say it's more you conceptualisation of body autonomy versus what you consider weight loss philosophies-or the fact that you consider weight loss to only be a thought, (not a reality) and that you consider it seperate to bodily autonomy. I would have thought weight loss was exactly about the latter.

I could go on, but I've finally come to accept that FA is a discussion between one type and mindset of people. They operate on shared premises-ones that I share so few of it seems, that it's just a continual state of hard work, merely to try and get my points across, I've tried, but I'll have to say that I've failed. I'm now tired of it, it's time for me to bow out.

HOLY.SHIT. I know for some it seems to be the only alternative, but I just can't bring myself to ever agree with anyone doing gastric bypass. I may not agree with it, but as written above, every adult makes his or her own decisions regarding their bodies.

I didn't read every comment, and I'm sure you intelligent commenters have already said what I'll repeat:

Why don't we look at fat people who don't have diabetes, who don't have high blood pressure, who have low to normal cholesterol? Perhaps the information might help fat people who do have these problems.

I believe it is doctors' job to MAXIMIZE the health of their patients. For smokers, this would include information about taking Vitamin C to reduce their nitrosamines, the level of which in the urine is directly related to development of lung cancer. It does not include screaming at people to make them stop smoking.

I believe one can be morbidly obese as I am and be quite healthy, which I am except for the infected hernia repair mesh they put in me eight and a half years ago (I knew better but was traumatized after a head-on collision), and all my sports injuries. Yes, a fat person with sports injuries! I have never had high blood sugar, high blood pressure, or high cholesterol. I don't think WLS is the answer to reducing these numbers; I think the answers exist, but they won't make bariatric surgeons rich. Or richer.

I just read this. I was quite annoyed with the term "my little pouch" before I even got to the end.

My sister had the Roux-N-Y several years ago. She recovered well and wasn't losing weight in the early weeks like her surgeons thought she should. So she ended up having to count calories to make sure she stayed right around 1000 or under, although sometimes she'd go higher and some days she'd stay lower, I guess it just depended on circumstances. Her daily caloric intake was about 600-1200 calories for the first year. I talked to her later and she said she had stopped counting calories, she hadn't had to do that in awhile.

But then later I talked to her, and she was talking about drugs she was taking, wanting to go off of them but then being afraid of weight gain. One drug acted as an appetite suppressant for her, and when she went off of it, she gained weight. She's since gained weight, I don't know how much. I don't know if she still takes the Topamax or not.

She had iron deficiency before she went into surgery, and got iron infusions so she could qualify. Then after the surgery she was having problems with anemia, but she could no longer afford to go to the doctor. She had insurance, but I guess she still owed them money from co-pays and whatever wasn't covered. It wasn't a lot, but she didn't have it, and she couldn't go to the doctor. Finally I lent her some money so she could go, and it turned out she had serious anemia, they put her in the hospital and gave her blood transfusions, since her blood level was low as well as her iron, and ended doing a hysterectomy. This whole thing kind of floored me, but I guess the state of medical care in this country is quite another topic. But I felt like the circumstances surrounding her surgery weren't particularly well handled, since they knew she had problems with anemia and they hadn't been able to diagnose them. At one point they were suggesting leukemia and autoimmune issues. So they gave her iron infusions so she would test OK for the surgery. Seems irresponsible to me.

This has been a spirited discussion. For truth in advertising, I mainly agree with Big Liberty. WLS is a sadistic procedure perpetrated by fat-hating doctors. It is surgically imposed starvation. There is at least 30 years of "research" on its dangers. Studies that support it are flawed. For example, a number of studies "follows up" only a small percentage of the sample because a large percentage "drop out".

That aside, WLS surgery has been suggested to me on at least a couple of occasions. Several years back, I saw an orthopedic specialist for sciatica pain. I wanted treatment of which there are a number of nonsurgical options. However, the first thing out of his mouth was--I won't operate on you unless you lose weight. He then suggested a buddy who did WLS. His fat hatred prevented him from providing me with competent treatment. So I searched out a different specialist. A few years later I moved and had to find a new primary care physician. She suggested WLS. As an interesting coincidence, the hospital where she practiced had just opened a new bariatric clinic. Coincidence--I think not. I asked her if she was familiar with WLS research regarding success (lack thereof), mortality rate, etc. After she answered, no, I asked her how she could recommend such a surgery when she was ignorant of its effects. She had no answer. Needless to say she is no longer my PCP. Her fat-hatred was evident in a number of other areas as well.

Alyssa, GOOD FOR YOU!!!!! Two years ago I saw three surgeons about my abdomen, which contains infected hernia repair mesh put in in 2002 (some was taken out five months later, but not all). The third surgeon was the first one very experienced at removing mesh and closing the hernia with your own muscle. However, he is in practice with bariatric surgeons and suggested WLS because I need to have a BMI under 40. He figured that would be a loss of 40 pounds. I have lost over 20 but have been at a plateau for a long time due to my beat-up body (falls off horses, etc) and long-term untreated hypothyroidism (treated now, but it takes time to overcome 40 years of doctor stupidity). My physical therapist ("You're not that big!"; I weighed 264 on the PT scale) wants me to try another surgeon and I'm thinking of doing so. I can't get into a water tank to get an accurate BMI due to ... guess what? ... the infection in my abdomen which drains continually. If I go anywhere else and anyone suggests WLS, I think I'll take a page from your book, Alyssa.